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CPAP Does Not Control Small Chokes
#1
CPAP Does Not Control Small Chokes
Hi all,

I'm a newcomer to the board but a long time CPAP user (most of a decade at this point). Unfortunately, despite using CPAP non-stop for many years, its effectiveness has been only about half as good as I would hope. I badly need it and can't do without it - but it also badly lets me down as I have a lot of what I call micro-chokes which still shatter my sleep quality and destroys my life. Explaining my issues to multiple different doctors has been about as useful as talking to a brick wall, so I'm hoping some of you may have some insight.

My story:

I am diagnosed with mild-to-moderate OSA, but my issues seem to be deeper than doctors understand. CPAP seems to work well to control actual apneas, both by my experience and my CPAP's data. What it doesn't seem able to prevent is these incredibly brief but violent choke events that are difficult to describe. I often notice these micro-chokes when I am in a half-asleep or semi-lucid state so I know they occur and how they shock me awake. 

How I can describe them is that I am inhaling through my nose, but partway through the inhale I can't get enough air in, and my body suddenly gets jolted as I suddenly inhale much harder to complete the breath. I don't think this can be called an apnea as technically I never stop breathing, but it feels like the breath hits a tripwire and I am snapped awake. I'm not sure my CPAP even registers the event but they seem to happen a huge amount. (I see a lot of you use software to read your own data - I have never tried this.) I wake constantly throughout the night.

It is worth noting that this problem does get worse when I am overweight, BUT it is still severe even when I am at my thinnest/ideal weight. In addition to seeing 3 different sleep specialists, I have been seen by a single ENT surgeon who told me he can't see a problem with my airways. I also recently saw a dentist about the possibility of a Mandibular Advancement Device, and while he acknowledged there was a possibility one could help he was unwilling to prescribe one.

Upon browsing this forum I'm seeing the term hypopnea come up. I was vaguely aware of the term before but it never came up with my doctors. Reading about it I'm unsure if my micro-chokes are hypopneas or something else.

The obvious questions are:

  • Do these micro-chokes sound familiar to anyone? Are they hypopneas or other?
  • Does anybody have any idea how to deal with this problem? My doctors sure don't.
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#2
RE: CPAP Does Not Control Small Chokes
Hi,

It is not uncommon that the doctors simply does not look at the numbers. If the see a low AHI they think all is good.

There are several parameters but I have especially noticed how little doctors care about mouth leaks so that is worth looking into. If you leak too much the machine have no chance to stop the obstruction or even register it. Or there are several other possibilites.

But to be able to tell you anything we really need data. Install OSCAR on your computer and get the SD card from your S9. In OSCAR you can then do a screenshot of the graphs by pressing F12. Upload that to this thread and we can help you interpret the data.

You have taken the first step - you are on the right path. There is a good chance you can find help here.

Kind Regards,
clan
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#3
RE: CPAP Does Not Control Small Chokes
Oh! And if you really do not want to fiddle with data then I would try the following:

1) Mouth tape
2) Slowly raising Pmin

If you find it harder with a higher pressure then you can enable EPR. That may feel nicer for you and then work. But in the same time you would usually have to raise Pmin even more.

And if you have been using the machine for years you might be better off disabling EPR. That gives better apnea control.

To get an idea of a better Pmin data would be preferable. Without you simply need to guess it. But I would expect 6-7-8 rather than 4.

But again: Data data data. Even if you are not a geek it is not that hard - it just looks like it. And if you have no SD card reader in your computer it is well worth the investment of EUR 10 - 20

/clan
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#4
RE: CPAP Does Not Control Small Chokes
Thank you, clan. I will see about getting the software and sharing the data.

Mouth leaks is a very good point - I forgot to mention that I often wake with a dry mouth or even find myself drooling, so it must be an issue. I can try some mouth tape.

I will have to check my machine but I think I have always had it with EPR on - if so, I will see what it's like turning it off.

What does Pmin refer to? Still learning some of the terminology!

Thanks again.
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#5
RE: CPAP Does Not Control Small Chokes
Pressure (P)
P min - minimum pressure
P max - maximum pressure

Your current pressure range is stated as 4-14 which is Pmin - Pmax.

Sorry to be abrupt - Late for dinner :-)
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#6
RE: CPAP Does Not Control Small Chokes
Thank you. I've downloaded my data into OSCAR - somewhat overwhelming to see for the first time. Let me know if more screenshots are necessary as I'm only beginning to grasp what I'm looking at.

       

There is also one complicating detail that may be responsible for the very recent jump in apneas that seems to be showing in this - I just noticed last week my machine telling me the motor life is exceeded. I am in a bit of a pickle figuring out what to do as ResMed no longer service the S9 and want me to upgrade to a new device whereas I'd rather fix the S9... In any case, very recent data may be different because the machine itself is not doing great. Just a night or two ago I also upped the Pmin from 4 to 9mbar.
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#7
RE: CPAP Does Not Control Small Chokes
Start with the Daily chart. That one tells us the most.
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#8
RE: CPAP Does Not Control Small Chokes
Here are 3 days from the last few weeks.


Attached Files Thumbnail(s)
           
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#9
RE: CPAP Does Not Control Small Chokes
Set your min pressure to 7 so the EPR can do its thing and manage your flow limits. That's the start.
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#10
RE: CPAP Does Not Control Small Chokes
I have used a S9 for around 29.000 hours. What pushed me to get a new one was when it stopped during the night (and started again). How precise the pressure is after that much time I do not know.

I do however know that after 7 years with the S9 the SD card stopped working. I got a Philips Dreamstation 1 from the health services but the nurse checkups were useless. I struggled to sleep with it and alternated between it and the S9.

I then found out by myself that I could not tolerate the A-Flex/C-Flex of the Philips even though it supposedly should be the same as EPR on the ResMed. Not so. It felt like I should adhere to a specific cyclic breathing pattern. With flex disabled I could sleep with it and it /felt/ like the ResMed.

My sleep slowly but seriously deteriorated. After 5 years (3 full time) with the Dreamstation 1 I was given a Dreamstation 2 a year ago (because of foam gate). It felt the same. No help from the doctors because my AHI looked good. Just after Christmas I tried the obvious: I found my old S9 and everything improved right away!

My point being: If you decide to spend money on a new one then I would recommend anything but Philips. I got the ResMed S9 AutoSet and Philips DreamStation 1 & 2 for free. I do not like to spend money but paying the EUR 620 to get away from Philips was the right choice for me!

See this controlled study:
https://journals.plos.org/plosone/articl...ne.0151530

To lazy to read? Watch this:
https://www.youtube.com/watch?v=v6_NHkXgSRU

The only one really struggling is the Philips System One. My personal experience tells me that Philips has not upgraded their algorithm.

ResMed is for sure the well-known and respected brand. If you want to stay with them the prices at my pusher is:

ResMed AirSense 10 AutoSet at EUR 650
ResMed AirSense 11 AutoSet at EUR 999

I have not heard about a lot of improvement in either motor or algoritm so I would personally have no problem choosing the previous model 10. Please correct me if I am wrong!

Based on the study and price I myself choose the Smart Plus a week ago. So far I have been very happy. At that time the prices were EUR 600 / EUR 620 but here just 7 days later they are:

Prisma Smart at EUR 648
Prisma Smart Plus at EUR 699

The plus model gives you app access to a very simple app which only show you a daily log for AHI and Deep Sleep. I was OK spending EUR 20 for that - but it is not worth EUR 49 for me. Oscar supports the Prisma nicely.

A review of the Prisma here:
https://www.youtube.com/watch?v=wqnTgmjmhnw

My pusher claimed that the "Smart" was a newer model and "Based on my experience, the touch screen of the A20 has been associated with several issues, particularly related to touchscreen functionality and its impact on machine usage and pressure adjustments."

But again: Most brands would probably work fine. I just want to warn you about Philips.

Kind Regards
clan

P.S. The Aussie in the above videos is not too popular around here as people *suspect* his SleepHQ software is using Oscar code under the hood. I do not have a dog in this race.
P.P.S. And as Gideon says: Daily chart! And do it by pressing F12 - it changes the view when screenshotting.
P.P.P.S. Under daily - the most interesting chart is your "Flow Rate". There you can watch you're breathing (or lack thereof) through the night.
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